多根针组合半环型外固定器用于小腿开放性骨折的治疗

Multi-pin Semicircular External Fixture in Treatment of Severe Open Comminuted Leg Fracture

目的 :探讨多根针组合式半环型外固定器在用于小腿开放粉碎性骨折治疗中的价值。方法 :自 1997年 6月～ 2 0 0 0年 2月对 11例小腿开放粉碎骨折的病人 ,创面在彻底清创后 ,采用皮肤的减张缝合、小腿局部带深筋膜的旋转皮瓣与外固定器技术相结合的方法治疗。其中应用小腿皮肤减张缝合 4例 ,局部带深筋膜的旋转皮瓣修复创面 3例 ,单纯缝合 3例 ,单纯换药 1例。固定方法 :加强组合半环式外固定器治疗多段、粉碎骨折 4例 ,标准组合半环式外固定器治疗粉碎骨折 7例。结果 :8例病人创面Ⅰ期愈合 ,1例合并双小腿大面积皮肤Ⅱ°烧伤的病人 ,经换药 1个月后伤口愈合。骨折愈合时间 4～ 9个月 (平均 5 .7个月 ) ,关节功能恢复良好 ,X线显示骨折全部达到骨性愈合时拆除全部外固定器。结论 :1彻底清创消灭创面是保证骨折愈合的关键步骤。 (2 )多根针组合半环式外固定器在用于小腿开放粉碎骨折的治疗中 ,是首选的治疗方法之一 ,能随意选择穿针的位置和穿针的平面 ,远离创口病灶区和架空创面固定骨折 ,手术操作简单 ,创伤小 ,固定牢稳可靠 ,便于在各种复杂情况下对骨折进行及时复位。

Objective:To evaluate the application of multi pin semicircular external fixture(MSEF)in treatment of severe open comminuted leg fracture(SOCLF).Method:Eleven cases of SOCLF were treated with thoroughly debridement,primary wound closure by simple suture(3 case),or decompression suture(4 cases)rotated fascia cutaneous graft(3 case)and dressing only(1 case).The fractures were manipulated fixed with MSEF to maintain a good alignment of comminuted tibia and providing a relative rigid fixation.Result:All the patients were followed up for 8 to 18 months,primary wound healing were seen in all cases but one burn case with secondary wound healing,bony fracture healing were demonstrated in all fractures in 4 to 9 months(Average 5.7 months)with a good alignment and satisfactory function.Conclusion:The result suggests that thoroughly debridement and primary wound closure are still the critical measures in treatment of SOCLF and MSEF is one of the best choice for SOCLF to provide,retative rigid fixation in a good alignment.